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JustBen July 15th, 2004 08:21 AM

Client vs. Patient
In the end, that server crash was probably a good thing. The old forum was terribly out-of-date and had some serious drawbacks (no registration, limited formatting options, no reteroactive editing capability, etc.)

I'd like to ask the entire group a question about terminology. Do you prefer the term patient or client? Please provide a rationale. I've heard good arguments on both sides of this debate, but I'm still uncertain as to which would be better. Do the theoretical underpinnings of CT suggest an answer? (I've read both terms used quite widely in CT literature.)

William Reid July 16th, 2004 05:24 PM

Re: Client vs. Patient
That's an easy one: "Patient." "Client" is not a bad second choice (especially compared to "consumer" or the Illinois DMH favorite, "recipient)" but "patient" wins out, in my view (yes, I'm an M.D.). Here are three reasons that make sense to me:

First, in spite of rampant decrying of clinical elitism and an over-striving for egalitarianism, "patient" conveys a specific responsibility for the clinician (which is, incidentally, recognized in many state laws related to standard of care and malpractice). "Patients" are special, and deserve special attention and professional competence. "Clients" seem to me a pretty generic bunch, with an (informal) implication that they are simply the ones paying the bill.

Second, the term "patient" implies to me an entitlement. The person is entitled not only to certain things from the clinician, but also to, at times, to be needy, or even "sick."

Finally, there is a very practical side to the "patient" role. A very nice "patient" (he prefers the term) with bipolar disorder was a senior consultant in the Clinton administration. (He went public with his condition long ago. The administration is irrelevant, although I must give Clinton credit for having the flexibility and good sense to keep his talents around the White House.) I had an opportunity to hear him speak twice in relatively small, professional groups, and on both occasions he strongly recommended that the mental health psychiatric community refer to people like him as "patients," and call their disorders "illnesses" rather than something like "problems of living." He was quite concerned that managed care companies, Congress, funding agencies, and others who influence the financing and regulations regarding mental health care would use "client," "behavioral health," etc. to place mental illness in a lower priority than other "medical" illness. His story made a big impact on me; I dedicated a book to him.

Bill Reid
Moderator, Law & Ethics forum

JustBen July 17th, 2004 11:55 AM

Re: Client vs. Patient
Thank you for the well-reasoned response, Dr. Reid. All three points were excellent, but I'm particularly intrigued by the third. As someone just beginning his career in mental health care, I have to admit to a low-level anxiety about these "status" issues.

Specifically, I'm worried that an upcoming proposed nationalized health care insurance system would leave my category of professionals, LPC's, (as opposed to psychiatrists, psychologists, and clinical social workers) out in the cold when it comes to reimbursement. While LPCs have a well-defined status in their respective states, I haven't seen much to indicate that the Federal Government even recognizes this category. (This is a particularly strong concern for me, because unlike most of my LPC colleagues, my primary interest is in establishing a private practice, as opposed to working out of a community clinic, which typically has multpile sources of public and private funding.)

loftus75 July 18th, 2004 02:58 PM

Re: Client vs. Patient
As a matter of interest here in the UK, patients or clients using mental health services are formally referred to as 'Users'. As an American living in the UK I find this term strange to say the least. How this term first came to be used I have no idea other than to suggest it has some politically correct inference. Perhaps it's also an illustration of another cultural difference between the USA and the UK.

James Pretzer July 22nd, 2004 09:53 AM

Re: Client vs. Patient
I was taught back in grad school (ages ago) that "patient" connotes a power differential where the "doctor" is in a superior role. The argument presented back then was that thinking in terms of "doctor" and "patient" encourages the individual seeking professional services to adopt a passive role where they sit back and wait for the "doctor" to cure them. It was argued that using the term "client" establishes a more egalitarian relationship where the individual seeking services and the professional providing services are on more of an equal footing and it is easier to get the "client" to be an active participant in therapy rather than being a passive recipient.

In reality, my bet is that there isn't one "right" answer to this one. In print, both terms get used. Personally, I lean towards "client" when I'm writing. However, I rarely use either with clients/patients. Typically, I address people by name and, when I need to refer to other clients/patients, I generally use a phrase like "the other people I work with."

It is important to treat those seeking our services with compassion and respect, to actively involve them in treatment, and to remember that professional training may make me more knowledgeable in some areas but does not make me superior to others. I'm not sure it makes a big difference if we use "patient" or "client."

William Reid July 22nd, 2004 07:58 PM

Re: Client vs. Patient
You are right, I think, that there are different reasons for appellations in different situations. The "power differential" reason for using "client," however, has never made sense to me (but then, I am decidedly against political correctness for its own sake). Of course there is a difference in power, which varies with the situation and patient, and which is not always in the direction of the therapist. The therapist's special knowledge and expertise, experience with patients, and at times even his/her authoritative role are routinely important in helping the patient. To say that a "power differential" is always bad is illogical.

Most people don't come to serious therapy to interact with an "equal" or a "friend." Patients really do want (and need) someone who is much better than they at solving the problem at hand (no matter what the depth of the problem or style of the therapy). That may include an ability to see things the patient can't see in himself/herself (which can sometimes be done with a mere friend, but not usually as well), but the additional expectation (by the patient) that the therapist is "powerful" enough to guide the patient to solve them is important. Respect is very important, as you point out; paying lots of attention to whether or not there is a "power differential" in the therapy setting seems silly to me.

Tom Szasz once told me in Syracuse, now some 20 years ago, that all he did with his analytic patients was "schmooz." I don't believe for a moment that that's enough.

B1ogie July 26th, 2004 11:41 PM

Re: Client vs. Patient
I agree with the position that people seeking mental health services should be referred to as patients. I agree for all the reasons mentioned. For psychologists, who need to be seen as "doctors'" and not second class professionals, it is also important. I think that the issue is probably moot. Many people who seek my help have referred to me as "the doctor." I've yet to hear someone call me the "helper," "faciltator," "I feel your pain guy," or whatever. When one is vulnerable, there is probably a deep human need for a kindly and authoritative expert to take a hand to help out and ameliorate one's suffering. Call it the "Marcus Welby effect," which is probably a nonspecific effect of therapy, and/or part of the placebo effect. I'm not sure you will get the placebo effect with other dyads. I call my dentist "Dr." (especially with a drill in his hand), as well as my PCP. So, the Dr.-patinet relationship works just fine for me. Some things simply do not need improvement, like Heinz ketchup. Some things are not political issues, they just are what they are.

Mike Greenberg

loftus75 July 29th, 2004 07:58 AM

Re: Client vs. Patient
It seems to me that the terms of recognition we use might depend on the circumstances. For example, if we are trying to empower a client to have the ability to assert themselves without aggression, as we might do with the passive/aggressive personality, placing them in a position that enforces their anxiety with authority could be counter-productive.

I am currently working with such a client. Due to life experiences this person is either in a state of subservience or aggression. For instance, when the session is going off course or becoming unproductive if I play the authority card this clients becomes completely out of control and requires considerable patience to avoid violence. Under these circumstances I have found, and not just in this instance, that a client that feels their autonomy remains intact, that is they see themselves as dealing with an equal, then progress is made at a faster rate and with longer term positive consequences. Of course there are lines that cannot be crossed when applying this process. For instance it is beholding on the therapist to identify the difference between inappropiate validation, that is where a client may be seeking approval for inappropriate behaviours, and positive reinforcement when the client has applied an effective assertive behaviour.

Experience tells me that clients are much more likely to follow a role model they can easily identify with, for many of the above types it is because they unable to identify with the authoritive figure that they find themselves in therapy.

J Cunagin August 24th, 2004 09:27 AM

Re: Client vs. Patient
I am also in favor of "patient". I first remember the Client vs. Patient issue being brought up in a Clincal Psychology course I took as an undergrad. At some point in the course, it was explained that there was a shift away from using the term patient in favor of client. The reason given was that it was an effort to remove the stigma associated with seeing a psychologist, or other therapist. I've never really accepted this reason as valid. I was trained as a family physician before going into psychiatry. All of the people I treated, whether for an ear infection, hypertension, diabetes or heart failure were identified as patients. I certainly don't believe any of them perceived themselves as being stigmatized by the term.

George Neeson November 12th, 2004 01:38 PM

Re: Client vs. Patient
In Canada, they are called "consumers" which worries me. Am I to be had for lunch ?? ;)

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